On Christmas eve-five days after announcing that its HMO received a one-year accreditation from the National Committee for Quality Assurance-Blue Cross of California dropped its suit against the NCQA, MODERN HEALTHCARE*has learned.
The timing of the two events may raise some eyebrows. But Jeffrey Rideout, M.D., Blue Cross vice president of quality management, said, "The cynics can draw whatever conclusions they want, but we earned (the accreditation)."
Blue Cross filed suit in October 1995, charging that its CaliforniaCare HMO failed to get accreditation because the NCQA's review process was flawed (Oct. 30, 1995, p. 10).
Both organizations say the accreditation comes because the review process has evolved and the HMO's quality has improved.
"We and the NCQA found a positive way to work with each other, and we as an organization are much more comfortable with the (review) process than we were in 1994," Rideout said.
"We continue to evolve our accreditation review process," an NCQA spokeswoman said. "There were no changes made to the process as a result of the lawsuit."
The major reason the first review led to denial is that the NCQA had not yet made its scoring guidelines public, Rideout said.